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This author details the case of a 71-year-old patient who had reperfusion procedures for occlusions at the dorsalis pedis and posterior tibial arteries, and subsequently had transmetatarsal and below-knee amputations.

In the past, surgery designed to heal wounds or reduce the risk for development of wounds in people with diabetes has been haphazard. A recently published pilot study in Gait & Posture suggests strongly that we can work toward predicting success preoperatively.1 See http://tinyurl.com/yzbkt96

Although the patient with diabetes and renal failure presents serious challenges to the limb salvage team, there is evidence and argument to support aggressive treatment and attempted limb salvage in a multidisciplinary clinical environment. An abundance of medical literature discusses the separate wound care challenges posed by diabetes and renal failure. Less work has been done, however, to identify proper treatment and salvage techniques for patients who suffer from both maladies.

For patients with diabetes and rigid forefoot deformities, traditional surgical procedures and prolonged offloading periods have a high risk of potential complications. Accordingly, these authors offer perspectives and step-by-step pearls on the use of percutaneous surgery and minimal incision surgery procedures.

I read with interest the recent article on diabetic limb salvage (“How To Form A Diabetic Limb Salvage Team” in the June 2010 issue). Over the last 14 years, I have been significantly involved with wound care and limb salvage in the diabetic patient population. In 1998, I was asked to join the staff of a multidisciplinary wound center associated with two local hospitals as a podiatric surgeon and wound specialist.

In the last several months, I have had the opportunity to attend four major wound care conferences. Standing in the back of the room at the Diabetic Limb Salvage conference, world famous researchers and academicians Peter Sheehan, MD, and Andrew Boulton, MD, commented to me how wonderful this meeting and others such as the American Professional Wound Care Association (APWCA) meeting had become in educating medical professionals on limb salvage.

These authors discuss how serial debridement, split thickness skin grafts and negative pressure wound therapy salvaged the limb of a 71-year-old patient with diabetes who presented with gas gangrene.

Gas gangrene of the lower extremity is one surgical emergency that normally requires extensive debridement and frequently results in lower extremity amputation. The physician must take into account the advantages of serial debridement with the use of split thickness skin grafts (STSG) and negative pressure wound therapy (NPWT) to salvage limbs.